Editorial

Abstract

This paper is an attempt to address the issue of trust in the therapeutic relationship from the counsellor's perspective, with a particular reference to working with drug addicts. It is a personal reflection on previous work with drug addicts in which a cognitive-behavioural approach was used. The comparison will be made, in a post hoc, reflective manner, on the issue of trust from a very different perspective; namely psychodynamic. It is suggested that the counsellor's trust in their own ability to contain the patient's often projected anxiety, is a central element or variable that can be seriously disrupted by the process of projective identification. And, moreover, it may have some explanatory power for the choice of method of working with this particular client population, that the issue of trust and its containment says as much, if not more, about us as counsellors, as it does about the client. It is argued that our anxieties may lead us to adopt a certain course of action in the therapy, rather than to address the possible meaning of these anxieties in terms of the relationship regarding the clients' needs.     

'What did we talk about last week?' a study of forgetting in one schizophrenic and two borderline clients in counselling

Abstract

This paper describes ‘forgetting between sessions’ by two borderline and one schizophrenic client in counselling. What was forgotten included: progress made, awareness of dependence, an experience of having a helpful and sympathetic counsellor, and the ability to think. Understanding of this phenomenon is explored in terms of schizoid mechanisms (Klein 1946), omnipotent narcissistic object relations (Rosenfeld 1987) and attacks on linking and thinking (Bion 1959, 1962). The need to avoid or evacuate painful experiences which are intolerable to the individual, or to recreate and remember existentially infantile traumata, are proposed to be some of the reasons behind this forgetting. The counsellor's capacity to remember, forget, contain, and think about the client's experiences is considered.     

Moments of empowerment: A qualitative analysis of positively experienced episodes in brief person‐centred counselling

38 positively experienced episodes in brief person‐centred counselling with six clients were analysed. The Interpersonal Process Recall (IPR) method was used as the prime research tool. Clients were asked to identify positively experienced moments in the counselling session during a post‐session review interview. Clients and counsellors were invited to report on the feelings, perceptions and intentions they recalled experiencing during these moments. Three analyses were used to categorise the meaning and feeling quality of these moments, and a taxonomy of types of positively experienced episodes was also created. The most frequently reported positive client experiences were associated with empowerment, safety and insight. Other significant themes emerging from the analysis included: freedom in the relationship, shortcomings of the relationship, assurance of the relationship, unfolding of the client's personal meaning, and the importance of the counsellor's presence. Taxonomy of episodes revealed nine categories: four of them focused on the strengthening of the therapeutic relationship, and five focused on the empowerment of the client's self. These findings are discussed, and implications for theory and practice explored.     

Occupational Therapy's Role with Victims of Domestic Violence

ABSTRACT

Occupational therapists encounter individuals who are victims of domestic violence in many different settings. The role of the occupational therapist with each client depends on that client's specific needs, the treatment setting, and the skills and beliefs of the therapist. This article presents a theoretical argument for why the occupational therapist should choose to be involved in the treatment of domestic violence. The Model of Human Occupation provides a framework for understanding functional issues related to domestic violence. Methods of assessment and treatment are presented using this model. A continuum of levels of involvement including referrals for resources or treatment, direct and indirect treatment and program consultation is offered. Each level is illustrated with case vignettes demonstrating the therapist's role. Issues related to the challenge of working in domestic violence and reasons that women may refuse intervention are also discussed.     

Overcoming My Model of Goodness as a Psychotherapist

Summary

The case of Tina is presented to examine one therapist's countertransference issues with a female client who had features of a Borderline Personality Disorder. The therapist's emotional reactions to this client's raw expression of anger and frustration are explored. The discussion also emphasizes the struggle of the therapist in resolving her discomfort with this client and in setting therapeutic boundaries.     

Brief encounters and available places to land

In this paper the author addresses the process of ending in brief therapy. While recognizing the importance of attending to the symbolic meaning of the ending itself and the need to interpret this as it manifests in the transference, he points out the limitations of such an approach. He highlights the significance of the environment of interpersonal relationships and family systems and the wider communities in which the client lives. He suggests that the therapist needs to assess the extent to which these can provide an environment that facilitates the client's development and working through as the therapy ends. The therapist needs to establish whether the patient will have an available place to land, and one that provides sufficient security and safety for the client's onward journeying and exploration without the therapist. The author's conceptualization of 'landing at the end of brief therapy' links together Malan's triangles of insight with Sullivan's concept of the ordinary solution and selective inattention and Gustafson's concept of dilemmas to add depth to the therapeutic effectiveness with which the practitioner can approach brief therapy in general, and the ending in particular. The article concludes with a case example that illustrates these themes.     

Philosophical Counselling, Truth and Self-Interpretation

Philosophical counselling, Ran Lahav and others claim, helps clients deepen their philosophical self-understanding. The counsellor's role is the minimalist one of providing the client with the philosophical tools needed for reflective self-evaluation. Respect for the client's autonomy entails refraining from intervening with substantive moral criticism, theories, and methods; the client's ways of working out fundamental questions like ‘Who am I and what do I really want?’cannot be assessed by the counsellor in terms of their truth-value, but only in terms of whether they reflect the client's autonomous choice to express him/herself in a certain way. I argue that this view, which is informed by an anti-realist account of self and life-history, undermines the distinction between self-knowledge and self-deception. Once interpretive and criteriological free rein is given to the client, and once personal, pragmatic and aesthetic considerations take precedence over truth-value, then the way is left open to clients to generate the most morally convenient self-interpretation to suit their current needs. I defend the view that truth matters in philosophical counselling; more specifically, that there is a basic distinction between true and false forms of self-understanding. To do this, I offer a broadly realist account of self and reflective self-evaluation. If this is right, then philosophical counsellors shoulder a significant burden of responsibility in helping their clients achieve an accurate, defensible, action-guiding and truth-oriented self-understanding.     

Writing therapy in brief workplace counselling: Collaborative writing as inquiry

The purpose of this collaborative research was to reflect on one client's experience of using writing therapy during brief workplace counselling. The client/co‐researcher used expressive and creative writing between counselling sessions, the benefits of which are reported. A brief review of the literature on writing therapy is provided. The focus of the study is on investigating the process of writing therapy from the client's point of view. The epistemological assumptions and research methods are influenced by narrative inquiry. Feminist values inform both the therapeutic practice and research.     

A qualitative exploration into how the use of prayer in counselling and psychotherapy might be ethically problematic

Aim: This research article contributes to the debate on the value and limitation of the use of spiritual strategies, like prayer, in counselling (Foskett & Lynch, 2001) by disseminating the insights that were gained from a qualitative study of mainstream counsellors whose work includes prayer. Method: Participants were 19 British Association for Counselling and Psychotherapy (BACP)‐accredited and Churches Ministerial Counselling Service (CMCS)‐approved counsellors who use prayer in their practice. They were interviewed, and the data were analysed using Interpretative Phenomenological Analysis. Results: The data reveal that counsellors who use prayer are aware that ethical problems may be encountered: if prayer changes the way that the counsellor is perceived; when using prayer with issues of psychopathology; if the counsellor uses prayer to impose faith on a client; when being professionally held to account; if prayer is used for avoidance or as a defence; if prayer is used to enhance the counsellor's power; if prayer is not part of the client's agenda; if prayer is used routinely; if prayer cannot be challenged; if there is a cultural pressure to pray; and if the prayer method is not matched to the client – but that their concern over potential ethical issues is not of sufficient strength to override their therapeutic use of prayer if facilitated with due care.     

A psychodynamic perspective on early childhood trauma in an adult: A case study

Abstract

This paper uses a long-term case to illustrate, from a psychodynamic perspective, a number of issues arising in working with an adult survivor of early childhood trauma. The paper takes an overview of the case study, identifying issues which are inextricably interwoven in the client's experience of trauma, and which impact on the working alliance. The therapeutic relationship forged with the client is discussed in terms of its intrinsic successes and failures together with the implications of early traumatic experiences for the termination of counselling.     

Psychoanalytic Interpretation of Superego Functioning Following CS Readministration Procedures: Case Illustration

The Comprehensive System (CS; Exner, 2003) has specific procedures to address brief Rorschach protocols when the first administration yields fewer than 14 responses. These procedures involve the assessor's asking the client to retake the test by providing more responses on the second administration than the first administration. The request carries with it an implicit criticism of the client's initial effort and a mandate to improve performance on retake. The retake request, with its ambiguously worded demand for improved performance, engages the client's superego (i.e., the client feels judged) and makes it possible to study superego manifestations (e.g., guilt, shame) on the Rorschach test, using a model of (a) brief first record, (b) retake directive, and (c) second administration. We present a case that illustrates a clinical strategy, modeled on a psychoanalytic understanding of the CS retake procedure, for studying the client's superego functioning under retest conditions.     

Parallel Process

Summary

This article addresses parallel processes between the author (a therapist) and client when each are mourning the death of their mother. Similarities and differences in their experience and reaction are discussed. The effect of the client's unexpressed grief from her early childhood loss is explored. The author also examines her own, more recent loss and develops a new perspective on its consequences. Tools are presented to help the client work on her grief, especially when the issue is “motherloss.” The impact of the therapeutic process on the client and author is delineated, and the client's reactions to ending her therapy are analyzed.     

Sexual Abuse Litigation

Summary

Practicing psychologist Janet Sonne and attorney Julian Hubbard illuminate how the different aims and languages of psychotherapy and law can be either an asset or a liability in the emotionally-charged environment of sexual abuse litigation. Properly understood, these differences can optimize the ability of each professional to assist their common client, the sexual abuse survivor, in the litigation process and beyond. Dr. Sonne reviews the psychological and behavioral sequelae of childhood sexual abuse and identifies six elements of the client's psychological functioning key to the litigation process, as well as posing questions for the attorney's self-evaluation for the unique demands of sexual abuse litigation. Mr. Hubbard then addresses what survivors and therapists need to know about the litigation process, exploring dynamics of legal strategy that can exacerbate the client's psychological problems. In the final section, both offer tips to enhance professionals' focus on education and communication as a means to better serving the sexually abused client.     

Building on an Empirical Foundation: Strategies to Enhance Good Practice

Reviews of the research literature on outcomes in counseling agree that counseling works. It is also possible to use research to identify strategies for increasing the probability of successful counseling. Such strategies include careful assessment of the client, matching the client and counselor on demographic and attitudinal variables, and maintaining a productive working alliance through open disclosure to the client of the counselor's background and procedures, inquiry into the client's experience of counseling process, and management of client resistance.     

Screening for Medical and Neurodevelopmental Disorders for the Professional Counselor

This article reviews several assessment factors useful identifying the presence of a possible medical illness or neurodevelopmental disorder contributing to a client's adjustment problems. Use of behavioral observations, record reviews, brief neuro-behavioral screening tests, and the taking of a history are outlined that can assist in raising the index of suspicion for organic influence. Also addressed are issues pertaining to referral for medical and specialty assessments, including neuropsychological evaluation.     

Cognitive behaviour therapy approach to assessing dysfunctional thoughts

Research shows that the client who is emotionally distressed will have many negative or dysfunctional thoughts. Some of these thoughts are irrelevant or less important to the patient's problem. This means that some thoughts are more central to the client's problem than the others. Among these relevant central thoughts, one thought is hypothesed to be the most central to the client's problem. This is known as a critical thought and should be the most appropriate cognitive target for intervention. In addition, this paper suggests that the therapist/nurse should treat each of the expressed emotions relating to a negative event as a separate entity for assessment. Rationale and clinical strategies for the assessment, particularly on the identification of the critical thought, are discussed.     

Psychotherapy and schizophrenia: An analysis of requirements of an individual psychotherapy for persons with profoundly disorganized selves

Many emerging views of outcome from schizophrenia emphasize that persons must recover a sense of their own identity, agency, and personal worth. While this is intuitively appealing and consistent with a wide range of literature, it raises the issue of how best to facilitate this. In this article we explore how integrative psychotherapy might address issues of narrative and recovery from schizophrenia among persons experiencing more profound levels of disorganization. Illustrated with a case example we explore in particular the barriers posed to psychotherapy by a client's cacophonous self-presentations. We then describe techniques from an integrative perspective that might help therapists enter dialogue with persons so afflicted. Our claim is that psychotherapy can revitalize dialogues within the client and between the client and others that enable the reconstruction of a personal narrative from which a life plan might be articulated.     

Tools for Change

Abstract

This paper discusses the ways in which one may incorporate political action into a client's therapy process so the client may incorporate it into her/his life. A framework for defining this as ethical, therapeutic and necessary to the client is presented. A number of suggestions for helping clients and therapists to become more politically active, as well as vignettes demonstrating how this might work with clients in the therapy process are provided.